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1 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIY SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�� Z�� (,!,''S I. s � <br />LEGA LOT NO. <br />D[SC. <br />OWNER ' <br />�ic r r� R C,Y� Q� <br />TENANT.`4ME <br />CONTqpCTOA <br />PHONE <br />PROPOSED USE OF FlUILDIN6 <br />CONTRACT PRICE OF WOpI( <br />PARCEL TAX I.D. M <br />'�� � 7 c.�c�o 0 3: <br />BLOCK TRACT <br />ADDRESS <br />_ 9 z o- �c�5—�t l� <br />ICONTACT NAME <br />ADDRESS <br />Building � Mechenical <br />PERMIT R Combination Plumbin0 <br />TYPE D Demolition Sign <br />U Sprinkler (x ol haetls� <br />WORK DE9CRIPTION ' <br />Lh�U�:.�l/'�l 'i ��e<T �OGt' <br />NO. TYPE OF FIXTURE OR REM <br />_ _ W�� I cH CLOSET (TUILET) <br />___ BATHTUB <br />___ LAVATORV (WASH BASIN) <br />6HOWER <br />_. KITCHEN SINK 8 DISPOSAL <br />. DISHW��SHER <br />_ LAUNDRVTRAY <br />... CLOTHES WASHER <br />URINAL <br />DRINKING FOUNT�IN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE�BAR/MOP/ETC.) <br />OTHER <br />PERMIT M <br />: 030�-0�1 <br />v�s-� s <br />PMONE <br />21P CONTR. LICEN9E M <br />Addition HEAT SOURCE <br />Allaretion n Electric <br />New K pes <br />fiepqlrlMelnt. LJ pther <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIl(TURE OR ITEM <br />�/v�. — �vIiHNULWCi UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />.__ UNIT HEATEfiS <br />__ CLOTh1ESDRY[R <br />_ RAN�E HOOD <br />_ '�NATER HEATER <br />__ MFTAL FlREPLACE/STOVF <br />_ FIREPLACE INSERT <br />_ GAS FIREPLACE <br />GAS RANGE <br />_� GAS PIPING <br />_.. EXHAUSTFAN <br />___ OTHER <br />I HFREBY CERITIFV THAT I HAVF READ AND E%AMWCD THIS APPLICATION AND KNOW ThIE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETi IER SPECIF IED HEREU; OR I <br />NOT THE GRANTING OF A pERMI � DOES NOT PRESUME TO GIVE AUTHORIT/ TO VIOLATE OF CAN�EL THE PROVISION OF ANV OTMER <br />STATE OR L�CAL LAW REGULATIP:G CONS7RUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHONZFD BV THE <br />JWNER OF THIS PROPERTV TO PERFORM THE WORN FOR WHICH APPUCATION Ig MADE AND I COMPLV WITh� THE STATE <br />CONTRACTORS LAW 1B 27 qCYi AND 2962U0 WAC � <br />�-� � -�-� ,r- �u�,3 � <br />Signelur f Owne:/ ontractor!Aulhonzed Agenl ale � <br />